静脉注射左西孟坦、多巴酚丁胺对脓毒症休克患者心肌抑制影响的对照性研究

目的 通过观察血流动力学指标以及机体炎症因子的改变探讨静脉注射左西孟坦对脓毒症休克患者心肌抑制的影响.方法 总共纳入2014年3月至2015年6月于我院治疗的脓毒症休克患者94例,在相同的基础治疗基础上,随机分为接受左西孟坦治疗组(观察组)和多巴酚丁胺治疗组(对照组);分别观察两组患者入组前、治疗3天以及7天各项指标的差异.结果 观察组和对照组在患者的平均年龄、性别构成以及基础病构成方面差异无统计学意义(P＞0.05);治疗前对两组患者的APACHE Ⅱ评分、GESVI以及血清PCT、BNP、以及Lac差异无统计学意义(P＞0.05).治疗3天以后:观察组BNP水平、Lac以及cTnl水平显著低于对照组,组间对比差异有统计学意义(P＜0.05).两组间GESVI对比差异无统计学意义(P＞0.05).连续治疗6d后,指标观测结果显示:观察组的GL以及GESVI水平显著高于对照组水平,BNP水平、Lac以及cTnl水平显著低于对照组,组间对比差异有统计学意义(P＜0.05).观察组与对照组相比,机械通气时间(P＜0.05)、住院时间较短(P＜0.05),并且APACHE Ⅱ观察组也较对照组低(P＜0.05).结论 应用左西孟坦治疗脓毒症休克患者的心肌抑制,有利于改善患者的心脏舒张和收缩功能,提高氧代谢,缩短机械通气时间和ICU住院时间,减轻机制的炎症反应,值得临床的推广应用.

Levosimendan Versus Dobutamine in Myocardial Injury Patients with Septic Shock.

Objective We aimed to investigate the effect of levosimendan on biomarkers of myocardial injury and systemic hemodynamics in patients with septic shock.Methods A total of 94 Patients diagnosis as septic shock and with a low cardiac output were recruited and then divided into two groups randomly:the observation group (given levosimendan) and control group (given dobutamine).The biomarkers of hemodynamic were tested before treatment and 3 days,6 days after treatment.Results The two groups had similar in APACHE Ⅱ score,GESVI,BNP level,Lac and cTnl before treatment.Three days after treatment,the serum levels of BNP,Lac and cTnl were lower than that in control group(P ＜0.05).GESVI was similar between two groups (P ＞ 0.05).Six days after the treatment,GESVI,BNP,Lac and cTnl were lower than that in control group (P ＜ 0.05).Conclusion Compared with dobutamine,levosimendan reduces biomarkers of myocardial injury,improves systemic hemodynamics in patients with septic shock and reduces the time of mechanical ventilation and the duration of ICU stay.